Erken dönem Kienböck hastalığının (evre 1-3A) 4+5 ekstansör kompartman vaskülarize kemik grefti ile tedavisi

Year 2026, Volume: 9 Issue: 1, 228 - 233, 05.01.2026

Zafer Güneş , Eralp Erdoğan

https://doi.org/10.32322/jhsm.1827790

https://izlik.org/JA28NJ69EE

Abstract

Amaç: Kienböck hastalığı lunat kemiğin avasküler nekrozu ile karakterizedir ve etiyolojisi halen tartışmalıdır. Vaskülarize kemik grefti (VKG), erken evre hastalıkta vaskülariteyi artırmak ve karpal fonksiyonları korumak amacıyla cerrahi bir seçenek olarak öne çıkmıştır. Bu çalışmanın amacı, 4. ve 5. ekstansör kompartman arterleri (ECA) temelli pediküllü VKG ile tedavi edilen evre 1–3A Kienböck hastalığı olgularının klinik ve fonksiyonel sonuçlarını değerlendirmektir.

Gereç ve Yöntem: Bu retrospektif kohorta, 2017–2023 yılları arasında tedavi edilen 22 hasta (7 evre 1, 9 evre 2, 6 evre 3A) dahil edildi. Cerrahi teknikte distal radiustan alınan kortikospongiyöz greft, 4+5 ECA pedikülü ile lunat defektine transfer edildi. Ameliyat sonrası 4–6 hafta kısa kol atel uygulandı ve ardından fizyoterapi başlatıldı. Sonuçlar preoperatif ve postoperatif 12. ayda değerlendirildi: el bileği fleksiyon–ekstansiyon arkı, ulnar–radial deviasyon, kavrama gücü, Görsel Analog Skala (VAS, 0–100 mm) ve QuickDASH skorları. Gruplar içi karşılaştırmalar eşleştirilmiş T-testi veya Wilcoxon testi ile, evreler arası karşılaştırmalar ise Kruskal–Wallis testi ile yapıldı.

Bulgular: Bir yıllık takipte anlamlı iyileşmeler izlendi: fleksiyon–ekstansiyon arkı (90.05°→128.00°, p=.000), ulnar–radial deviasyon (32.05°→37.60°, p=.000), kavrama gücü (23.59→37.59 kg, p=.000), VAS (65.23→22.45, p=.000) ve QuickDASH (55.60→19.60, p=.000). Alt grup analizinde her evrede (1, 2 ve 3A) tüm parametrelerde anlamlı düzelme saptandı (p=.000). Evreler arası karşılaştırmalarda anlamlı fark bulunmadı (tüm p>.05). Üç hastada (%13.6) yüzeyel yara enfeksiyonu görüldü ve oral antibiyotik ile düzeldi. Donör saha morbiditesi, nörovasküler komplikasyon veya greft kaybı izlenmedi.

Sonuç: 4+5 ECA temelli pediküllü vaskülarize kemik grefti, erken evre Kienböck hastalığında güvenli ve etkili bir tedavi seçeneği olup, minimal komplikasyon oranı ile anlamlı fonksiyonel iyileşme ve ağrı kontrolü sağlamaktadır. Evre 1–3A hastalarında elde edilen iyileşme düzeyleri benzer olup, bu evreler arasındaki hastalık şiddetinin kısa dönem sonuçları belirgin şekilde etkilemediği görülmüştür. Uzun dönem etkinliği değerlendirmek ve bu yöntemi alternatif cerrahi seçeneklerle karşılaştırmak için daha geniş örneklemlere sahip prospektif çalışmalara ihtiyaç vardır.

Keywords

Kienböck , Lunatum , Avasküler nekroz , 4+5 ekstansör kompartman

Management of early-stage Kienböck disease (stages 1–3a) with vascularized bone grafting

https://izlik.org/JA28NJ69EE

Abstract

Aims: Kienböck’s disease is characterized by avascular necrosis of the lunate, with its etiology still debated. Vascularized bone grafting (VBG) has emerged as a surgical option for early-stage disease to improve vascularity and preserve carpal function. This study aimed to evaluate clinical and functional outcomes of stage 1–3A Kienböck’s disease treated with a pedicled VBG based on the 4th and 5th extensor compartment arteries (ECAs).
Methods: This retrospective cohort included 22 patients (7 stage 1, 9 stage 2, 6 stage 3A) treated between 2017 and 2023. Surgical technique involved harvesting a corticospongious graft from the distal radius, transferred on the 4+5 ECA pedicle into the lunate defect. Postoperatively, a short-arm splint was applied for 4–6 weeks, followed by physiotherapy. Outcomes were assessed preoperatively and at 12 months: wrist flexion–extension arc, ulnar–radial deviation, grip strength, Visual Analog Scale (VAS, 0–100), and QuickDASH. Paired comparisons were performed with the paired T-test or Wilcoxon signed-rank test; comparisons among disease stages (stage 1, stage 2, and stage 3A) were performed using the Kruskal–Wallis test.
Results: At one year, patients demonstrated significant improvements: flexion–extension arc (90.05°→128.00°, p<.001), ulnar radial deviation (32.05°→37.60°, p<.001), grip strength (23.59→37.59 kg, p<.001), VAS (65.23→22.45, p<.001), and QuickDASH (55.60→19.60, p<.001). Subgroup analysis confirmed significant within-stage improvements (p<.001for all parameters). Interstage comparisons revealed no statistically significant differences in outcomes (all p>.05). Superficial wound infection occurred in three patients (13.6%) and resolved with oral antibiotics. No donor-site morbidity, neurovascular complications, or graft failures were observed.
Conclusion: The 4+5 ECA-based vascularized bone graft appears to be a safe and effective option for early-stage Kienböck’s disease, providing meaningful short-term clinical and functional improvement with a low complication rate. However, due to the retrospective design and the absence of standardized radiological outcome measures, the present findings should be interpreted as short- to mid-term clinical results rather than evidence of radiological revascularization or prevention of disease progression. Further prospective studies with larger cohorts are warranted to confirm long-term efficacy and to compare this
technique with alternative surgical strategies.

Keywords

Kienböck , lunate , avascular necrosis , 4+5 extensor compartment

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